Prognostic scoring system for primary CNS lymphomas: The International Extranodal Lymphoma Study Group experience

Andrés J M Ferreri, Jean Yves Blay, Michele Reni, Felice Pasini, Michele Spina, Achille Ambrosetti, Antonello Calderoni, Andrea Rossi, Vittorio Vavassori, Annarita Conconi, Liliana Devizzi, Françoise Berger, Maurilio Ponzoni, Bettina Borisch, Marianne Tinguely, Michele Cerati, Mario Milani, Enrico Orvieto, Juvenal Sanchez, Christine ChevreauStefania Dell'Oro, Emanuele Zucca, Franco Cavalli

Research output: Contribution to journalArticle

Abstract

Purpose: To identify survival predictors and to design a prognostic score useful for distinguishing risk groups in immunocompetent patients with primary CNS lymphomas (PCNSL). Patients and Methods: The prognostic role of patient-, lymphoma-, and treatment-related variables was analyzed in a multicenter series of 378 PCNSL patients treated at 23 cancer centers from five different countries. Results: Age more than 60 years, performance status (PS) more than 1, elevated lactate dehydrogenase (LDH) serum level, high CSF protein concentration, and involvement of deep regions of the brain (periventricular regions, basal ganglia, brainstem, and/or cerebellum) were significantly and independently associated with a worse survival. These five variables were used to design a prognostic score. Each variable was assigned a value of either 0, if favorable, or 1, if unfavorable. The values were then added together to arrive at a final score, which was tested in 105 assessable patients for which complete data of all five variables were available. The 2-year overall survival (OS) ± SD was 80% ± 8%, 48% ± 7%, and 15% ± 7% (P = .00001) for patients with zero to one, two to three, and four to five unfavorable features, respectively. The prognostic role of this score was confirmed by limiting analysis to assessable patients treated with high-dose methotrexate-based chemotherapy (2-year OS ± SD: 85% ± 8%, 57% ± 8%, and 24% ± 11%; P = .0004). Conclusion: Age, PS, LDH serum level, CSF protein concentration, and involvement of deep structures of the brain were independent predictors of survival. A prognostic score including these five parameters seems advisable in distinguishing different risk groups in PCNSL patients. The proposed score and its relevance in therapeutic decision deserve to be validated in further studies.

Original languageEnglish
Pages (from-to)266-272
Number of pages7
JournalJournal of Clinical Oncology
Volume21
Issue number2
DOIs
Publication statusPublished - Jan 15 2003

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Lymphoma
Survival
Brain
Basal Ganglia
Serum
L-Lactate Dehydrogenase
Methotrexate
Cerebellum
Brain Stem
Proteins
Drug Therapy
Therapeutics
Neoplasms

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Prognostic scoring system for primary CNS lymphomas : The International Extranodal Lymphoma Study Group experience. / Ferreri, Andrés J M; Blay, Jean Yves; Reni, Michele; Pasini, Felice; Spina, Michele; Ambrosetti, Achille; Calderoni, Antonello; Rossi, Andrea; Vavassori, Vittorio; Conconi, Annarita; Devizzi, Liliana; Berger, Françoise; Ponzoni, Maurilio; Borisch, Bettina; Tinguely, Marianne; Cerati, Michele; Milani, Mario; Orvieto, Enrico; Sanchez, Juvenal; Chevreau, Christine; Dell'Oro, Stefania; Zucca, Emanuele; Cavalli, Franco.

In: Journal of Clinical Oncology, Vol. 21, No. 2, 15.01.2003, p. 266-272.

Research output: Contribution to journalArticle

Ferreri, AJM, Blay, JY, Reni, M, Pasini, F, Spina, M, Ambrosetti, A, Calderoni, A, Rossi, A, Vavassori, V, Conconi, A, Devizzi, L, Berger, F, Ponzoni, M, Borisch, B, Tinguely, M, Cerati, M, Milani, M, Orvieto, E, Sanchez, J, Chevreau, C, Dell'Oro, S, Zucca, E & Cavalli, F 2003, 'Prognostic scoring system for primary CNS lymphomas: The International Extranodal Lymphoma Study Group experience', Journal of Clinical Oncology, vol. 21, no. 2, pp. 266-272. https://doi.org/10.1200/JCO.2003.09.139
Ferreri, Andrés J M ; Blay, Jean Yves ; Reni, Michele ; Pasini, Felice ; Spina, Michele ; Ambrosetti, Achille ; Calderoni, Antonello ; Rossi, Andrea ; Vavassori, Vittorio ; Conconi, Annarita ; Devizzi, Liliana ; Berger, Françoise ; Ponzoni, Maurilio ; Borisch, Bettina ; Tinguely, Marianne ; Cerati, Michele ; Milani, Mario ; Orvieto, Enrico ; Sanchez, Juvenal ; Chevreau, Christine ; Dell'Oro, Stefania ; Zucca, Emanuele ; Cavalli, Franco. / Prognostic scoring system for primary CNS lymphomas : The International Extranodal Lymphoma Study Group experience. In: Journal of Clinical Oncology. 2003 ; Vol. 21, No. 2. pp. 266-272.
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AU - Blay, Jean Yves

AU - Reni, Michele

AU - Pasini, Felice

AU - Spina, Michele

AU - Ambrosetti, Achille

AU - Calderoni, Antonello

AU - Rossi, Andrea

AU - Vavassori, Vittorio

AU - Conconi, Annarita

AU - Devizzi, Liliana

AU - Berger, Françoise

AU - Ponzoni, Maurilio

AU - Borisch, Bettina

AU - Tinguely, Marianne

AU - Cerati, Michele

AU - Milani, Mario

AU - Orvieto, Enrico

AU - Sanchez, Juvenal

AU - Chevreau, Christine

AU - Dell'Oro, Stefania

AU - Zucca, Emanuele

AU - Cavalli, Franco

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N2 - Purpose: To identify survival predictors and to design a prognostic score useful for distinguishing risk groups in immunocompetent patients with primary CNS lymphomas (PCNSL). Patients and Methods: The prognostic role of patient-, lymphoma-, and treatment-related variables was analyzed in a multicenter series of 378 PCNSL patients treated at 23 cancer centers from five different countries. Results: Age more than 60 years, performance status (PS) more than 1, elevated lactate dehydrogenase (LDH) serum level, high CSF protein concentration, and involvement of deep regions of the brain (periventricular regions, basal ganglia, brainstem, and/or cerebellum) were significantly and independently associated with a worse survival. These five variables were used to design a prognostic score. Each variable was assigned a value of either 0, if favorable, or 1, if unfavorable. The values were then added together to arrive at a final score, which was tested in 105 assessable patients for which complete data of all five variables were available. The 2-year overall survival (OS) ± SD was 80% ± 8%, 48% ± 7%, and 15% ± 7% (P = .00001) for patients with zero to one, two to three, and four to five unfavorable features, respectively. The prognostic role of this score was confirmed by limiting analysis to assessable patients treated with high-dose methotrexate-based chemotherapy (2-year OS ± SD: 85% ± 8%, 57% ± 8%, and 24% ± 11%; P = .0004). Conclusion: Age, PS, LDH serum level, CSF protein concentration, and involvement of deep structures of the brain were independent predictors of survival. A prognostic score including these five parameters seems advisable in distinguishing different risk groups in PCNSL patients. The proposed score and its relevance in therapeutic decision deserve to be validated in further studies.

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